Insurance fraud is costly to insurance providers and ultimately to their customers. A common form of insurance fraud occurs when services that were actually provided are represented to the insurance company as something more, or the services that were rendered are “upcoded” to more expensive and/or elaborate goods and services. In an attempt to combat insurance fraud, some insurers provide their policy holders with a statement of benefits (i.e., a statement of the payments) that were provided to a third-party service provider under an insurance policy. These benefit statements are also known as an “explanation of benefits” or an “EOB.” Insurers frequently ask their insureds (i.e., their insured customers) to verify that services listed on an EOB were actually rendered.
At least one problem with combating insurance fraud using an EOB is that many services and especially medical procedures, are not understood by a lay person. Asking a lay person to confirm his or her receipt of a medical procedure described in technical jargon on an EOB is problematic. At least with regard to health-care, insured persons frequently have no understanding of services they were provided or billed for and are therefore unable to confirm the contents of a billing statement from a medical service provider. In instances where services are provided without the insured's understanding of them makes it difficult for an insurance provider to determine whether or not a claim made by service providers is legitimate. A method and system by which a fraudulent claim can be more accurately identified would be an improvement over the prior art.